Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

Background: To compare the efficacy and safety of the combined application of both drain-clamping and tranexamic acid (TXA) versus the single use of either application in patients with total-knee arthroplasty (TKA). Methods: Databases (EMBASE, PubMed, Cochrane Library, Web of Sciences, the Google database, and the Ovid database) were searched from their inception through April 2018 for randomized controlled trials (RCTs) comparing the combined application of both drain-clamping and TXA versus single use of either application in patients with TKA. The Cochrane risk of bias (ROB) tool was used to assess the methodologic quality. The primary outcomes were blood loss in drainage, total blood loss, transfusion rate, and hemoglobin decline. The secondary outcomes were postoperative complications, the Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The statistical analysis was performed with RevMan 5.3.5 software. Results: A total of five RCTs (479 participants) were included in our meta-analysis. The present meta-analysis indicated that significant differences existed in the total blood loss (mean difference [MD] = −145.86, 95% confidence interval [CI]: −228.64 to −63.08, P = .0006), blood loss in drainage (MD = −169.06, 95% CI: −248.56 to −89.57, P < .0001), hemoglobin decline (MD = −0.66, 95% CI: −1.00 to −0.33, P = .0001), and transfusion rate (MD = 0.44, 95% CI: 0.26–0.75, P = .002) between the groups. However, regarding postoperative complications, no significant differences were found between the 2 groups in the KSS and the WOMAC score (P > .05). Conclusion: Combined application of both drain-clamping and TXA was associated with significant reductions in blood loss in drainage, total blood loss, hemoglobin decline, and the need for transfusion. However, high-quality, well-designed RCTs with long-term follow-up are still required.

[1]  Wan-chun Wang,et al.  Tranexamic acid plus drain-clamping can reduce blood loss in total knee arthroplasty: A systematic review and meta-analysis. , 2018, International journal of surgery.

[2]  Yan Zhang,et al.  Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty , 2017, Medicine.

[3]  F. Pei,et al.  Clamping drainage is unnecessary after minimally invasive total knee arthroplasty in patients with tranexamic acid , 2017, Medicine.

[4]  Li Jie,et al.  Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty: A meta-analysis: Erratum , 2017, Medicine.

[5]  Li Jie,et al.  Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty , 2016, Medicine.

[6]  Sang Hong Lee,et al.  Comparison of Blood Loss between Neutral Drainage with Tranexamic Acid and Negative Pressure Drainage without Tranexamic Acid Following Primary Total Knee Arthroplasty , 2016, Knee surgery & related research.

[7]  Xin-long Ma,et al.  Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta‐analysis , 2016, Orthopaedic surgery.

[8]  M. Pitta,et al.  Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610‐patient consecutive case series , 2016, Transfusion.

[9]  D. Dennis,et al.  Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial , 2016, Clinical orthopaedics and related research.

[10]  Z. Wei,et al.  The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta‐analysis of 2720 cases , 2015, Transfusion medicine.

[11]  Hao Wang,et al.  Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. , 2014, The Knee.

[12]  F. Haddad,et al.  A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. , 2014, The bone & joint journal.

[13]  Cemal Kural,et al.  Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty. , 2014, Balkan medical journal.

[14]  P. Woratanarat,et al.  Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial , 2013, BMC Musculoskeletal Disorders.

[15]  Zeyu Huang,et al.  Meta-analysis of temporary versus no clamping in TKA. , 2013, Orthopedics.

[16]  C. Pornrattanamaneewong,et al.  Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial , 2012, BMC Musculoskeletal Disorders.

[17]  C. Pornrattanamaneewong,et al.  Three-hour interval drain clamping reduces postoperative bleeding in total knee arthroplasty: a prospective randomized controlled trial , 2012, Archives of Orthopaedic and Trauma Surgery.

[18]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[19]  U. Udomsubpayakul,et al.  Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: a prospective triple-blinded randomized controlled trial , 2011, Orthopedic reviews.

[20]  I. Jou,et al.  Temporary drainage clamping after total knee arthroplasty: a meta-analysis of randomized controlled trials. , 2010, The Journal of arthroplasty.

[21]  A. Ferretti,et al.  Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique , 2009, International Orthopaedics.

[22]  Ajay Kumar.  Perioperative management of anemia: Limits of blood transfusion and alternatives to it , 2009, Cleveland Clinic Journal of Medicine.

[23]  I. Nilsson,et al.  Experimental and clinical studies on AMCA, the antifibrinolytically active isomer of p-aminomethyl cyclohexane carboxylic acid. , 2009, Scandinavian journal of haematology.

[24]  P. Mannucci,et al.  Prevention and treatment of major blood loss. , 2007, The New England journal of medicine.

[25]  C. Hing,et al.  DRAIN CLAMPING IN KNEE ARTHROPLASTY, A RANDOMIZED CONTROLLED TRIAL , 2007, ANZ journal of surgery.

[26]  M. Serra-Prat,et al.  Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. , 2006, British journal of anaesthesia.

[27]  I. Jou,et al.  Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty. , 2005, The Journal of arthroplasty.

[28]  N. Kiely,et al.  Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. , 2001, The Knee.

[29]  N. Takada,et al.  Comparison between 1-hour and 24-hour drain clamping using diluted epinephrine solution after total knee arthroplasty. , 2001, The Journal of arthroplasty.

[30]  H. Kuokkanen,et al.  Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. , 2000, The Journal of arthroplasty.

[31]  R. Abbate,et al.  Effect of Tourniquet Use on Activation of Coagulation in Total Knee Replacement , 2000, Clinical orthopaedics and related research.

[32]  T. Sculco.  Global blood management in orthopaedic surgery. , 1998, Clinical orthopaedics and related research.

[33]  J. Ylinen,et al.  Tranexamic Acid Radically Decreases Blood Loss and Transfusions Associated with Total Knee Arthroplasty , 1997, Anesthesia and analgesia.

[34]  S. Lethagen,et al.  The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. , 1997, Thrombosis research.

[35]  M. Lamy,et al.  High‐dose Aprotinin Reduces Blood Loss in Patients Undergoing Total Hip Replacement Surgery , 1994, Anesthesiology.

[36]  A. Minami,et al.  Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. , 2012, The Journal of arthroplasty.

[37]  J. Ryu,et al.  The postoperative drain-clamping method for hemostasis in total knee arthroplasty. Reducing postoperative bleeding in total knee arthroplasty. , 1997, Bulletin (Hospital for Joint Diseases (New York, N.Y.)).

[38]  M. Hoylaerts,et al.  Studies on the mechanism of the antifibrinolytic action of tranexamic acid. , 1981, Biochimica et biophysica acta.